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New York Obstetrical Society
Society Transactions NEW YOUK OBSTETRICAL SOCIETY Meeting of January 14, 1996
The following papers were presented: Polyneuritis of Pregnancy. Dr. Arthur W. Bingham. (For original article see page 144.) Motion Picture of the Anatomy and Technic of the Parametrial Fixation Operation. Dr. Robert 'f. Prank. Dr. Frank stated that for a period of over twenty·five years he had sought for a satisfactory operation for the cure of uterine prolapse and the one about to be described was the best method he had found. «Some years ago I checked up on 414 patients who had been treated by the method which was employed at Mount Sinai for many years, namely, anterior and posterior colporrhaphy with ventral fixation. Dr. Ma:,;: D. Mayer and Dr. Howard E. Lindeman studied these cases and found that only 66 per cent of the cases gave satiafaetory results, and of the unsatisfactory ones 21 had ventral hernias. That was extremely discouraging, particularly as the most seriously ill patients were operated upon by the men on the service who had had the most experience. It appeared that the results varied inversely to the experience of the operator, the worse the ease the worse the result, the more often the hernia. Then I tried vaginal hystereetomy, not very many cases, doing a fairly elaborate operation, such as was advocated by Dr. G. G. Ward, Dr. Goff, the Mayos, etc. Before I discarded the operation, except in cases where for some reason a prolapse was present and the uterus had to be removed as well, as for fundal carcinoma, I found that simple vaginal hysterectomy with adequate resection of the vaginal walls gave as good a result as the more elaborate technics. Then I thought tl1at perhaps the operation which was so commonly used in England and whkh according to their follow·up, and I will say that their follow· ups were extremely lax from our point of view, very often depending on post·eard data, was so marvelously successful that I saw no reason why it should not be trierl. Then I essayed to find somebody who knew the operation, but was unable to find any one. So I went ahead myself from the descriptions which I could find, which were mainly those of Fothergill and Shaw, and while I saw much suturing I found little anatomy. Therefore, I hail to work it out, step by step, until I understood both the anatomy and the operation. "I claim no, originality whatsoever. The operation was first done by Donald of Manchester in 1888. Fothergill and Shaw were his pupils and continued it. Donaltl was not the type of surgeon given to writin,g-, so Fothergill and Shaw did the describing and popularizing of the operation. Therefore, if you wish to attach the name of any man to the operation it should be known as Donald's or perhaps the Manchester operation. '' Halban described the operation through one of his pupils, Meetids, in 1932, who called it Halban 's operation, although he had only done it from 1919 on, and I will add in passing that he understood the anatomy of the operation fully. ''Recently, Professor Tandler said to me: 'The operation is based on entirely false principles, but clinically it is sueeessful.' I am unwilling to concede this because Tandler 's point of view is that the musculature of the pelvis, particularly the levators, is the structure whi
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vaginal hysterectomy, where there is no prolapse, will a~:ree that as soon as the broad ligaments are cut, the uterus will descellfl with ease, and I personally think that it is the broad ligamentH-I do not mean the intraperitoneal thin portion, but the bases of the broad ligaments-which normally hold the derus, the levators taking up the extra shocks as a shock absorber. ''The operation is based on the following: ''That the amputation of the cervix with exposure of the broad ligaments is fol· lowed by an aseptic condensation of these elastic tissues, the same type of condensa· tion that you find after an inflammatory process, say, a frozen pelvis: these tissues never returning to their previous resiiiency. The operation can be used for any case in which, under an anesthesia, the portio can readily be pulled down to the introitus. It can be used too in the most extreme cases of. prolapse, and, furthermore, it can be used in these difficult cases where a prolapBe of the cervix ilevelops after a supra>aginal hysterectomy.''
CHICAGO GYNECOLOGICAI1 SOCIETY Meeting of December teO, 1935. The following paper and case reports were presented:
A stnil.y of Three EUlldred and Eight Cases of Placenta Previa. Dr. F. C. Irving (by invitation). (For original article Ree page 36.) Abdominal Aneurysm. Dr. F. H. Falls. (For original article see page 164.) Interstitial Pregnancy. Dr. A. E. Kanter. (For original article see page 167.) Metastatic Carcinoma. to the Ovary from the Voc11,l Cord. Dr. J. D. Kirshbaum. (For original article see page 165.) A Case of Carcinoma-Sarcoma of the Uterus. Dr. Carey Culbertson.
BROOKLYN GYNECOLOGICAL SOCIETY Meeting of November 1, 19/Jli
Beport of a Case of Cyclops. Dr. David Kupferstein. Meeti!ng of December 6, 1985. The Effects of Progestin on Afterpains. Dr. Samuel Lubin and F. J. Clnrke. (For original article see page 134.) :Results of Treatment in Placenta Previa. Dr. Joshua Ronsheim. (For orig· ina! article see page 139.) Total Hysterectomy by the Abdominal Versus the Vaginal Bonte in Benign Uterine Disease. Dr. E. H. Richardson, Baltimore, Jl.fd. (by invitation). (To be included in the October issue.}
WASHINGTON GYNECOLOGICAL SOCIETY MeeHn.CJ of November !!3, 1935 The following papers were presented: Further Improvement in Pelvimetric Roentgenography. Dr. .J. Bay Jacobs. (For original article see page 76.) X,XOflbrosarcoma of the Ovary. Dr. Clayton H. Hi:xRon. (For original article see page 162.)
The following papers were presented: Polyneuritis of Pregnancy. Dr. Arthur W. Bingham. (For original article see page 144.) Motion Picture of the Anatomy and Technic of the Parametrial Fixation Operation. Dr. Robert 'f. Prank. Dr. Frank stated that for a period of over twenty·five years he had sought for a satisfactory operation for the cure of uterine prolapse and the one about to be described was the best method he had found. «Some years ago I checked up on 414 patients who had been treated by the method which was employed at Mount Sinai for many years, namely, anterior and posterior colporrhaphy with ventral fixation. Dr. Ma:,;: D. Mayer and Dr. Howard E. Lindeman studied these cases and found that only 66 per cent of the cases gave satiafaetory results, and of the unsatisfactory ones 21 had ventral hernias. That was extremely discouraging, particularly as the most seriously ill patients were operated upon by the men on the service who had had the most experience. It appeared that the results varied inversely to the experience of the operator, the worse the ease the worse the result, the more often the hernia. Then I tried vaginal hystereetomy, not very many cases, doing a fairly elaborate operation, such as was advocated by Dr. G. G. Ward, Dr. Goff, the Mayos, etc. Before I discarded the operation, except in cases where for some reason a prolapse was present and the uterus had to be removed as well, as for fundal carcinoma, I found that simple vaginal hysterectomy with adequate resection of the vaginal walls gave as good a result as the more elaborate technics. Then I thought tl1at perhaps the operation which was so commonly used in England and whkh according to their follow·up, and I will say that their follow· ups were extremely lax from our point of view, very often depending on post·eard data, was so marvelously successful that I saw no reason why it should not be trierl. Then I essayed to find somebody who knew the operation, but was unable to find any one. So I went ahead myself from the descriptions which I could find, which were mainly those of Fothergill and Shaw, and while I saw much suturing I found little anatomy. Therefore, I hail to work it out, step by step, until I understood both the anatomy and the operation. "I claim no, originality whatsoever. The operation was first done by Donald of Manchester in 1888. Fothergill and Shaw were his pupils and continued it. Donaltl was not the type of surgeon given to writin,g-, so Fothergill and Shaw did the describing and popularizing of the operation. Therefore, if you wish to attach the name of any man to the operation it should be known as Donald's or perhaps the Manchester operation. '' Halban described the operation through one of his pupils, Meetids, in 1932, who called it Halban 's operation, although he had only done it from 1919 on, and I will add in passing that he understood the anatomy of the operation fully. ''Recently, Professor Tandler said to me: 'The operation is based on entirely false principles, but clinically it is sueeessful.' I am unwilling to concede this because Tandler 's point of view is that the musculature of the pelvis, particularly the levators, is the structure whi
174
SOCIETY TRANSACTIONS
17:i
vaginal hysterectomy, where there is no prolapse, will a~:ree that as soon as the broad ligaments are cut, the uterus will descellfl with ease, and I personally think that it is the broad ligamentH-I do not mean the intraperitoneal thin portion, but the bases of the broad ligaments-which normally hold the derus, the levators taking up the extra shocks as a shock absorber. ''The operation is based on the following: ''That the amputation of the cervix with exposure of the broad ligaments is fol· lowed by an aseptic condensation of these elastic tissues, the same type of condensa· tion that you find after an inflammatory process, say, a frozen pelvis: these tissues never returning to their previous resiiiency. The operation can be used for any case in which, under an anesthesia, the portio can readily be pulled down to the introitus. It can be used too in the most extreme cases of. prolapse, and, furthermore, it can be used in these difficult cases where a prolapBe of the cervix ilevelops after a supra>aginal hysterectomy.''
CHICAGO GYNECOLOGICAI1 SOCIETY Meeting of December teO, 1935. The following paper and case reports were presented:
A stnil.y of Three EUlldred and Eight Cases of Placenta Previa. Dr. F. C. Irving (by invitation). (For original article Ree page 36.) Abdominal Aneurysm. Dr. F. H. Falls. (For original article see page 164.) Interstitial Pregnancy. Dr. A. E. Kanter. (For original article see page 167.) Metastatic Carcinoma. to the Ovary from the Voc11,l Cord. Dr. J. D. Kirshbaum. (For original article see page 165.) A Case of Carcinoma-Sarcoma of the Uterus. Dr. Carey Culbertson.
BROOKLYN GYNECOLOGICAL SOCIETY Meeting of November 1, 19/Jli
Beport of a Case of Cyclops. Dr. David Kupferstein. Meeti!ng of December 6, 1985. The Effects of Progestin on Afterpains. Dr. Samuel Lubin and F. J. Clnrke. (For original article see page 134.) :Results of Treatment in Placenta Previa. Dr. Joshua Ronsheim. (For orig· ina! article see page 139.) Total Hysterectomy by the Abdominal Versus the Vaginal Bonte in Benign Uterine Disease. Dr. E. H. Richardson, Baltimore, Jl.fd. (by invitation). (To be included in the October issue.}
WASHINGTON GYNECOLOGICAL SOCIETY MeeHn.CJ of November !!3, 1935 The following papers were presented: Further Improvement in Pelvimetric Roentgenography. Dr. .J. Bay Jacobs. (For original article see page 76.) X,XOflbrosarcoma of the Ovary. Dr. Clayton H. Hi:xRon. (For original article see page 162.)